Approach to the orthopaedic patient

Question 1

What should be done with thoracic limb lameness assessment?

Answer 1

• Assess when patient walking towards you
• Head Position =
  -Attempts to shift weight caudally
  -Head will rise when lame leg in stance phase of gait cycle
  -Head will drop when lame leg is in swing phase
• Short stance phase on lame leg
• Fast swing phase on non-lame leg

Question 2

What should be done with pelvic limb lameness assessment?

Answer 2

• Assess when patient walking away from you you
• Hip Position =
  -Attempts to shift weight cranially
  -Hip hike – hip rises vertically when lame leg in stance phase of gait cycle
  -Head will drop when lame leg is in stance phase
• Short stance phase on lame leg
• Fast swing phase on non-lame leg

Question 3

Why would you want to watch patient at stance?

Answer 3

• May toe touch or transfer weight away from lame leg

Question 4

What would you assess on your physical exam?

Answer 4

• Always assess normal leg first
• Assess soft tissue =
  -Muscle mass + symmetry
  -Joint effusion
  -Tendinous insertions
• Palpate long bones
• Assess joints =
  -Range of motion
  -Periarticular thickening
  -Crepitus

Question 5

What is therapeutic strategy of orthopaedic patients?

Answer 5

• Exercise modification
• Physiotherapy
• Analgesia = NSAID + paracetamol
• Weight management

Question 6

What should be done for exercise modification?

Answer 6

• Lead-restricted exercise =
  -reduce to 25% of a typical walk (2-3x daily)
• Increase length of each walk by 5 mins every 7-14days (Max walk = 40mins)
• Introduce off-lead work when lead restricted target achieved

Question 7

What is the most common cause of thoracic limb lameness?

Answer 7

Elbow problem

Question 8

If a cat is lame, what does it usually have?

Answer 8

• Fracture
• Or cat bite abscess - would be pyrexic / unwell